Vox pop: Trusting the process and processing the trusting

by Pauline Dolan

The term vox pop comes from the Latin ‘vox populi’, meaning the ‘voice of the people.’ They are generally short published or broadcast interviews about matters of public interest.

At the AGM of the Irish Association of Humanistic and Integrative Psychotherapy (IAHIP) in Cork last year (March, 2016), a proposal was put forward to find a way to create a structure to encourage discussion and debate for those interested in articulating their vision for IAHIP, ICP (the Irish Council for Psychotherapy) and the psychotherapy profession in general – this proposal was supported by the members present. While the proposal was in relation to incoming Chairs making themselves and their vision known to the members prior to election, I was curious to know how members felt about various things happening on the ground. Having served on the IAHIP Governing Body, I know how much work goes into keeping the business side of the organisation going. In recent years, both a consultative forum and regional sections, linking committees with each other and the regions around Ireland, were created by Frank Dorr and implemented by the then Governing Body. Inside Out also provides a valuable link for members to express their views. However, despite all the many selfless, unpaid hours given by those volunteering on various committees on IAHIP, the perception is that there is a lack of cohesiveness, not only within IAHIP but also between the psychotherapy modalities. I believe that this perception filters down to individual members not having a sense of belonging to a vibrant, articulate Irish psychotherapy community. The IAHIP regional meetings are a valuable forum and I would like to see invitations to these meetings extended to members of the other psychotherapy modalities to stimulate conversation and foster a sense of community.

I am grateful to Terry Lynch, Ger Murphy, Trish Murphy, Annie Sampson and Matthew Henson for taking the time to share their views by email to the following four questions with the instruction to:“Feel free to refuse to answer, ignore, disagree with any question.”

I developed the first question from a statement in Minister Simon Harris’ Department of Health briefing paper on statutory regulation for counselling and psychotherapy, as reported in the Irish Times (Cullen, 2016), and the second from a headline by journalist Donal Lynch in the Irish Independent (Lynch, 2016). The third question came from my concerns that individual trainees would need lots of support to understand how systems operate, and the fourth was an open question to allow the participants freedom to comment on a topic of their choosing.

Vox pop questions:

Question 1:
“Unlike other professions that have been previously regulated…counsellors and psychotherapists do not form a cohesive professional body.” Health Minister Simon Harris, TD.

Even though humanistic psychology continues to influence therapy, education and healthcare, as a body we have failed to create good governance. How can we change that? Would you support the idea of withholding membership fees to bring about dialogue? Did you respond to the Minister’s recent request for submissions on regulation?

Question 2:
“The mental health stigma has faded but quacks are thriving. Therapy is no longer a dirty word but the lack of regulation means we still don’t know where to turn to.” Irish Independent Analysis, Donal Lynch: 11/12/2016

As someone who has invested so much in your training how would you respond to Donal Lynch’s piece in the Independent?

Question 3:
Brene Brown’s 2010 definition of boundaries is “What’s ok – What’s not ok!”

Are you okay with training organisations allowing their trainees to be exploited by charities and low cost counselling services and would you encourage supervisors to form a collective to report their concerns?

Question 4:
What question could I ask that would best represent what you would like to say?

For ease of reading these four questions are not repeated for each vox pop participant but are referred to briefly by their question number.

Dr. Terry Lynch, MIAHIP, GP, author, mental health activist, physician and psychotherapist, has served on many Irish government-appointed mental health groups. Described by psychiatrist Professor Ivor Browne as “enlightened” and by psychiatrist Pat Bracken as “a true scientist”, his latest (third) book is called Depression Delusion Volume One: The Myth of the Brain Chemical Imbalance. He has just launched an on-line-course, Depression, its true nature: A comprehensive course for mental health practitioners. www.doctorterrylynch.com

“One of the most pressing issues in mental health as I see it surrounds the global medicalisation of human distress. I would like to see psychotherapy organisations having the courage to contribute to addressing this major issue.”

Question 1:
I have heard that one of the problems giving rise to the issues raised above by Simon Harris TD, is that the various counselling and psychotherapy bodies have been unable to organise a cohesive unity in relation to regulation. I don’t know how true that is, but I have heard it on several occasions.

I’m not clear on what fees are been suggested, if it were IAHIP I would not feel comfortable doing that.

I didn’t respond to the recent invitation. I am working with other priorities, and I didn’t know of Simon Harris’ comments until now. I would have thought that the solving of this lies primarily with those at the top of the various associations/organisations.

Question 2:
There is some truth in these comments by Donal Lynch. People don’t know where to turn. I am regularly asked by people living in other towns for therapist recommendations, because people cannot figure out how to choose or identify a ‘good’ therapist.

Question 3:
I certainly have concerns about low-cost counselling. I personally will not work with an organisation that tries to set fees at rates that are in my opinion considerably out of kilter with what well trained therapists should receive.

I would certainly encourage organisations to consider this matter seriously, and perhaps to develop a unified stance, if that is possible.

Question 4:
One of the most pressing issues in mental health, as I see it, surrounds the global medicalisation of human distress. I would like to see psychotherapy organisations having the courage to contribute to addressing this major issue.

The public have formed grossly incorrect understandings of mental health, due to the ongoing medicalisation of human distress. Many therapists I know privately express many concerns about this, not least, the difficulties they face in working with clients who are also taking prescribed psychiatric medication. I am referring, for example, to the mass diagnosis of depression and prescribing of antidepressants (more than 60 million annually now in England, that’s more than the population of England). What the public do not realise, but many therapists do realise (to some degree at least) is that the evidence for such approaches is suspect, and certainly does not justify current levels of medicalisation. Surely – since therapy organisations purport to concern themselves with important issues relating to the public good in relation to mental health – this is an issue regarding which, therapy organisations should no longer remain silent???

The regulation issue is very important – it is an overarching issue that dilutes both the public credibility of psychotherapy and the ability of associations to stand firm on major national mental health matters.

Ger Murphy has worked in the field of psychotherapy for almost 25 years. He is a founder member of ICP and IAHIP and has served on the editorial board of several international psychotherapy journals, written numerous articles and is a founder member of Inside Out. He works as a trainer, supervisor, consultant to training programmes and organisations.

“We can have the more detailed conversation on areas of difference among ourselves, but not expect the public to differentiate between the different brands of therapy. But let us be clear what it is – therapy offers a relationship to help people change relationships (with self/ others/substances/work/world).”

Question 1:
Good governance is important but only after the profession has a clear coherent mission statement that distinguishes it from other pursuits, and clearly identifies the value of our work, in this Minister Harris is correct. For example, we could call our pursuit counselling/therapy, the designation currently used by the HSE. This clearly includes psychotherapy and counselling, and is understood by the public. In fact, it would be fine also to call it psychotherapy which subsumes counselling, we all treat the psyche to a greater and lesser depth. For the public we will be known as ‘therapy’ whether or not we wish it. We can have the more detailed conversation on areas of difference among ourselves, but not expect the public to differentiate between brands of therapy. But let us be clear what it is – therapy offers a relationship to help people change relationships (with self/others/substances/work/world). This would differentiate our work from teaching of skills, and from psychology which involves such teaching and assessments, etc. Governance follows clarity of purpose and mission not the other way around.

Question 2:
Donal Lynch is correct – people don’t know where to turn because the therapy profession has not clearly identified itself yet. There is confusion between services offering techniques, skills, assessments, and relational treatments. Therapy offers relational treatment for dysfunctional relationships and does it by offering a relationship as a source of cure, such a focus on the use of relationship as the ground of change is unique.

Question 3:
Yes, I think there is a quid-pro-quo for trainees getting experience in low cost services. If there are ethical concerns about this of course they should be voiced but the practice of trainees getting such experience and post graduation experience also in this way is valid.

Question 4:
I would like to address the question of how we make our offering relevant and valuable to society in general. We stand for the importance of reflection on the interior life, and do this in the context of the world we find ourselves in, using the medium of a therapeutic relationship. Psychotherapy has a valuable part to play in societal conversations on addiction, on self-harm and self-relating, on relationship breakdown, on climate change and ecological crises. We must be less precious in our belief systems and ideologies which isolate us from mainstream conversations. Many in society see psychotherapists as ‘precious’ and ‘narcissistic’ and unwilling to explain clearly what we do and how we can add value to people’s suffering lives. Our over-emphasis on empathy and non-judgementalism can leave our therapeutic relationships stilted, one-sided and unsatisfying for clients who want to engage with a real person of passion, curiosity, depth and self-reflection, and who genuinely engages in a real relationship to model a truly intimate and helpful presence. We must work to demystify what we do and we must find platforms on which we can speak to issues of common concern from a particular and valid standpoint. We need to clearly differentiate our offering from a medical or psychological one and show the value of our psychotherapeutic perspective to society.

 

Trish Murphy, B.S.S, M.S.S, M.A, C.Q.S.W, ICP is a family therapist and a member of ICP. She is a regular contributor to the Irish Times and the Ray Darcy show. Her book, The challenge of retirement pulls together the extensive knowledge Trish has gained from her many years as a psychotherapist, trainer, facilitator and mediator. She teaches at Trinity College Dublin.

“The question is how to make the public aware of the level and depth of the training and experience of psychotherapists – and also of the quality and rigour of the monitoring by the Irish Council of Psychotherapy.”

Question 1:
Question 1 is about humanistic psychotherapy and I am not qualified to answer that question.

Question 2:
The lack of regulation is a serious issue and we in ICP hope to become regulated as psychotherapists, so that the public can be assured of our level of training and qualifications.

Question 3:
I think it is important for trainees to secure really good internships and trainee opportunities and this can also serve a public need. The need is for those organisations to provide a real and substantial benefit to those in training and this could be monitored by ICP or by Coru?

Question 4:
The question is how to make the public aware of the level and depth of the training and experience of psychotherapists – and also of the quality and rigour of the monitoring by the Irish Council of Psychotherapy and all of the professional bodies of the five modalities. Psychotherapy is a stand-alone profession, though it is closely linked to psychology and counselling.

Annie Sampson, MSc, IAHIP, ECP, maintains a private psychotherapy and supervision practice in Limerick and is course director of Super.Vision Training. She works as a trainer and supervisor with the Tivoli Institute and University of Limerick. For the past six years Annie has traveled to Nepal where she trains therapeutic practitioners in supervision, psychotherapy and group facilitation.

“How can I as a professional support tolerance, justice, and the ethos of humanistic philosophy? How can I / psychotherapy be heard?”

Question 1:
Good governance is about having the structures, policies and processes in place to govern, and being able to monitor these practices. As a body, IAHIP is constantly faced with the challenges of putting processes in place as well as reviewing and updating ones already in place. As an IAHIP member who has served on two different committees, one in the late 90s and the other during the last few years, I know that the time and knowledge needed to competently fulfil the role is huge and is growing. As a busy practitioner it was challenging to take on the work of the committee, giving time for meetings and the work between meetings, struggling with questions of governance along with other issues. I wonder if we should review our ways of governing and look at other models of governance which might serve us better. I also want to acknowledge and thank those who have served on committees, working on my and the public’s behalf, and who continue to do so. Thank you.

Question 2:
I question if regulation will stop ‘quacks’, or incompetent practitioners working in the profession. We will know ‘where to turn’ for practitioners but a register will not stop the incompetent. We need only look to medical practice or other professions to see that there are incompetent practitioners, whether they are registered or not. Maybe this is a fact of human nature. We need to ensure our training criteria remain at a very high standard. Over the years, I have noticed ‘quacks’ or incompetent practitioners in lots of professional areas not remaining in their chosen profession, as the public have voted with their feet and money, staying clear of these practitioners. Word of mouth is a strong force.

Question 3:
Exploited is a very emotive word. Trainees seeing clients in charities and counselling services get access to screened clients, suitable to the trainee’s level of training and experience, or should do. Trainees get to work in the business of therapy. When the trainee’s placement is supportive of the trainee and enhances their development then this is a two-way contract that works well. What does need to be addressed is the fact that trainees successfully complete their supervised client work and training but are still not deemed eligible for accreditation and are therefore seen by others as not fully qualified.

Question 4:
How can I as a psychotherapist, how can psychotherapy as a profession, contribute to and be relevant to the changes we are now facing in our communities, nations and world? How can I as a professional support tolerance, justice, and the ethos of humanistic philosophy? How can I /psychotherapy be heard? On another note, as a practitioner in private practice I am always faced with the difficulty and question of getting the work/life balance, balanced. CPD, ongoing training, reading, keeping up with current research, seeing clients balanced with what nourishes me as a human being. An ongoing difficulty and a continual question.

Matthew Henson is an existential psychotherapist (UKCP) and ecotherapist in private practice. He is a trainer with Cork Counselling Centre Training Institute, a former Fitness to Practice panel member for BACP, a current Fitness to Practice panel member for MPTS and a member of Psychotherapists and Counsellors for Social Responsibility. Website: www.matthewhenson.ie
Email: info@matthewhenson.ie

“Psychotherapy is the stuff of life and life is never perfect; it is messy, ambiguous, complex and often contradictory. There is no single cohesive way to live correctly. Ipso facto there can be no single cohesive way to practice psychotherapy correctly.”

Question 1:
In my estimation, regulation is the single most pressing issue that psychotherapy is facing and, with others, I did respond to the consultation exercise to express my concern. Statements about the apparent paucity in governance of humanistic psychology/psychotherapy are a) disputable and b) a red herring that sets up a dangerous scenario which could see state regulation adopted in a format that threatens the very existence of many valid, including humanistic, approaches. The set-up is that we are being asked to choose between ‘good [state] governance’ on the one hand or a system of terrible lawlessness (in which rogue practitioners run riot) on the other. This not only misrepresents the reality of the current situation, but also oversimplifies and falsifies the terrain. A much more sophisticated appreciation of the landscape is required.

The field and scope of psychotherapeutic theory and practice is superbly rich in its range and breadth, with an abundance of therapeutic models and practices for clients to choose between. A problem is created rather than solved if we attempt to contort that wealth of diversity into a single “cohesive professional body”. The current system of voluntary accredited registration through bodies like IAHIP recognises the essential need for pluralism, which we are in danger of losing.

Psychotherapy is the stuff of life and life is never perfect; it is messy, ambiguous, complex and often contradictory. There is no single cohesive way to live correctly. Ipso facto there can be no single cohesive way to practice psychotherapy correctly. The governance of that myriad of unique practices we refer to as psychotherapy must reflect that reality.

Question 2:
Journalists will often jump on bandwagons without taking the time to adequately research the subject area and that is what has happened here. Mr. Lynch misrepresents good therapeutic practice and his use of humour is insulting and offensive. But any response, other than no response, gives this kind of journalism more power than it warrants.

Question 3:
I think this question needs to be viewed within the broader socio-political context of how psychotherapy is valued in our society, where resources for public services are scarce. Many therapists and trainee therapists are in the privileged position of not needing to earn money and are happy to volunteer in the genuine sense of the word. In these situations, everyone wins. However, the voluntary sector is potentially open to exploitation. In the UK, a new union for counselling and psychotherapy has recently been established, which aims to support its individual members, but also to promote the interests of psychotherapy and counselling generally. The exploitation of newly qualified, pre-accredited practitioners is one of its principal concerns. I would like to see, and perhaps be involved in starting, a similar union in Ireland. I have no problem with supervisors forming a collective to report abusive and exploitative practices, but I don’t think it is enough to tackle the problem on an organisation-by-organisation basis. Across the board, we need to be better at valuing psychotherapy in line with its proper worth and vigorously campaigning for resources that accurately reflect our contribution to the wellbeing of our communities, which would increase wages and reduce the need for volunteers.

Question 4:
Great question! I would like to be asked about the relationship between psychotherapy and politics. When I started my training in existential psychotherapy 16 years ago, I had only a limited sense that I was entering into such an intense political arena, but the more I practice and the more I develop my knowledge and awareness, the more I see clearly that it is impossible to practice psychotherapy apolitically. Whenever I make a statement about my practice, I am essentially making a political statement. Do I practice psychotherapy as something complimentary to medicine or as an alternative to it? Do I believe in the existence of an unconscious in the Freudian sense? Is therapy about curing illness? How is success measured? How much should psychotherapists charge? Am I for state regulation or against it? The answers to those, and just about every other question we must ask ourselves as practitioners are, at least in part and often entirely, political. For me personally, that realisation brings feelings of anxiety mixed with excitement – I think that lovely Irish word sceitimíní captures the feeling well.

Acceptance of the inevitability of the socio-political impact of psychotherapeutic practice opens possibilities on a global scale. Psychotherapy has a lot to offer in terms of how we understand, for example, the psychological mechanisms at play in the genocides occurring at this very moment and the anthropocentrism that threatens our planet. My wish is for the potential positive socio- political impact of our profession to be fully realised.

Vision and Freedom

We sent our vision like a swan on the river
The vision became a reality
Winter became summer
Bondage became freedom
And this we left you as your inheritance
O generations of freedom
Remember us
The generations of the vision

(From Mac Uistin, 1976)

Acknowledgement: Grateful appreciation to the Editorial Board for their support and help in bringing something different and a little innovative ‘over the line’.

Pauline Dolan MIAHIP, ICP, IAAAC, DipMedia Studies, is a founding member of Cork Creative Counselling and Therapy and is in private practice in Ballincollig Healing Centre.

References:
Brown, B. (2010). The gifts of imperfection (p.111). Minnesota: Hazeldene Publishing.

Cullen, P. (2016, September 1). Psychotherapists and counsellors to be regulated. The Irish Times. Retrieved 18 January 2017 at http://www.irishtimes.com/news/health/ psychotherapists-and-counsellors-to-be-regulated-1.2776352

Lynch, D. (2016, December 11). The mental health stigma has faded but the quacks are thriving. The Irish Independent. Retrieved 18 January 2017 at http://www.independent.ie/opinion/ analysis/the-mental-health-stigma-has-faded-but-quacks-are-thriving-35284300.html

Mac Uistin, L. (1976). We saw a vision. The Garden of Remembrance, Dublin, Ireland.

IAHIP 2017 - INSIDE OUT 81 - Spring 2017